Face Transplant Surgery

The first US face transplant surgery returned home last month after a successful operation to replace 80 percent of her face.

The patient, who wishes to remain anonymous, suffered a traumatic accident several years ago that left her with no nose, right eye or upper jaw. Her injuries mean she could not smell or eat normally.

In a ground-breaking 22 hour operation, led by reconstructive surgeon Dr. Maria Siemionow, the patient received a new nose, lower eyelids, upper lip and teeth, skin, muscles, bone, hard palate, arteries, veins and nerves from a donor who had just died.

Siemionow, who has been working on face transplant research for 20 years, received approval from the Institutional Review Board in 2004 to conduct a full facial transplant. The operation was carried out last December.

“She can actually feel the new face, and she does not feel the difference between her old face and her new face,” Siemionow said.

Siemionow said her recovery has been astonishing. The patient shows no signs of rejecting her new face and is doing well on standard immune-suppressing drugs. She now breathes normally instead of through a hole in her windpipe

“Before surgery, she couldn’t smell at all…

“She can recognize perfumes, she can eat and smell her hamburger … she can drink her coffee from the cup.”

“She can wink her eye,” Siemionow added, “and two weeks ago she ate pizza for the first time in years.”

Her disfigurement made it impossible to drink from a cup but now:

“She enjoys cookies with her coffee…

“She loves hamburgers. For years, she could not eat chicken,”

The patient, who’s appearance had frightened children, said:

“I’m happy about myself…

“The scars are nicely hidden because it’s such a large transplant…

“We are really pleased with the outcome.”

The woman must return a couple of times a week for follow-up care as she still needs restorative dental work.

Siemionow said in a December news conference when the transplant was announced. Now, she has found inner happiness and confidence with the new face.

“It’s something that will give a lot of hope to other patients,” Siemionow said.

Although it has been technically possible to carryout face transplant operations for years, the ethical concerns have been somewhat controversial.

Unlike other transplant patients who receive vital organs in order to survive, face transplant surgery is done to improve quality of life.

However leading physician groups and bioethicists praised the Cleveland case and have warmed to idea that certain carefully selected patients who have exhausted other forms of reconstructive surgery, may benefit from a face transplant operation.

“I believe this procedure is justified because you need a face to face the world,” Siemionow said.

Face transplant surgery is a complicated procedure and recipients run the increased risk of cancer and infections. Patients must also take immune-suppressing drugs for the rest of their lives to prevent organ rejection.

The Cleveland Clinic has received a military grant to further investigate face transplants in the hope that the procedure may be used on soldiers injured on the battle field. Siemionow visited Brooke Army Medical Center in San Antonio a few months ago to consider potential candidates.

The nations first face transplant operation was the worlds forth recorded face transplant.

The ground breaking operation which inspired doctors to attempt the first face transplant, was a full face replant carried out over 10 years ago by Dr. Abraham Thomas, one of India’s top microsurgeons.

The World’s First Face Replant

Nine-year-old Sandeep Kaur was horrifically injured by a grass-cutting machine that completely amputated her face and scalp.

The machine caught Sandeep’s hair and pulled her head in, her mother, who saw the accident said:

“I didn’t know where her face was. Everything was peeled off.”

Sandeep Kaur’s face arrived in two pieces at a hospital in India.

Dr. Thomas said:

“It was actually quite a frightening sight…

“The first response was ‘Oh my, God, I cannot do that (reattach her face).”

Dr. Thomas proceed with the face replant and the operation was a success.

Sandeep’s operation is considered the world’s first full-face replant.

The World’s First Face Transplant Surgery

French surgeons carried out the first face transplant surgery in the world in 2005, on a 38-year-old woman who had been severely mauled by her dog.

Isabelle Dinoire lost her nose, lips and chin in the incident, which left her unable to speak or eat properly.

After extensive counseling, Dinoire received a new nose, chin and lips from a brain-dead donor. The tissues, muscles, arteries and veins were taken from a brain-dead donor and attached to her lower face.

The operation was carried out by team led by Professor Bernard Devauchelle and Professor Jean Michel Dubernard.

The procedure, which lasted approx 5 hours, was the first to use skin from another person.

Apart from some rejection episodes, the patient is reportedly doing well.

Face Transplant Ethics

Despite the success of several face transplant procedures, the moral issues surrounding face transplant surgery still remains. At the time of the French patients surgery, Iain Hutchison, an oral-facial surgeon at Barts and the London Hospital, said:

“Where donors would come from is one issue that would have to be considered…

“The transplant would have to come from a beating heart donor. So, say your sister was in intensive care, you would have to agree to allow their face to be removed before the ventilator was switched off.”

“The extent of facial expression which will occur in the long term is unknown…

“The skin tends to promote rejection by the immune system very strongly and immunosuppression is likely to need to be kept at high levels for prolonged periods of time…

“It is not clear whether an individual could be left worse off in the event that a face transplant failed.”

Nevertheless, the positive outcome of such surgeries promises valuable medical advancements for the future. Mr Michael Earley, a member of the Royal College of Surgeon’s facial transplantation working party, said:

“If successful, this is a major breakthrough in facial reconstruction.”

Two others have since received partial face transplants a Chinese farmer attacked by a bear and a European man disfigured by a genetic condition.